Acessibilidade e utilização das redes de atenção primária e especializada por mulheres com HIV na perspectiva de usuárias e profissionais

Abstract

The accessibility and utilization of Primary Health Care (PHC) optimize the diagnostic and early management of the infection by the Human Immunodeficiency Virus (HIV) and the shared management of care, positively affecting the health of the woman and child. The infected women access different health services during pregnancy, however, intersectoral communication is not established and there is discontinuity in puerperium, which negatively influences on the access of these women. The research objective was to collectively develop actions to promote the access of women with HIV to Specialized and PHC services of a city in the southern region of Brazil. It is a participatory research, which developed the knowledge creation cycle proposed by the Knowledge to Action Framework, in the period from September 2016 to October 2017. Three techniques for data production were developed, which were: interview with 14 women, 45 hours of records in field diary from participant observation in the services; and four focus group meetings with 11 professionals and managers. The content analysis structured the results in the subjects accessibility and utilization. The psychosocial accessibility indicated: positive communication, cultural and communicational barriers. Positive communication demonstrated that support, welcome, conversation and guidance promote the treatment follow-up by the women and reflect in the return to the health service. However, disrespectful assistance results in a conflicting relationship and impairs the access. The communication barriers indicated that unavailability, misunderstanding or divergence of information reflect negatively in the access, showing a necessity for training, co-responsibility and communication between services. The cultural barriers, such as confidentiality and prejudice, generate insecurity for the access. In temporal accessibility, the waiting time does not hinder the access, but causes dissatisfaction or preference for some services in the network. In geographical accessibility, the proximity of the PHC services to their homes and the transportation availability to the specialized service facilitate the access. Regarding the utilization, the first contact with the service was due to exposure to HIV, illness or pregnancy. The access to the PHC occurred through transfer between services, according to professional indication or by the user herself. The PHC takes responsibility for non-specific demands of the infection and shares the assistance with the specialized service in cases of immunizations, non-emergency assistance and examinations. The preference for the specialized service derives from the capacity to meet the users’ needs. There is continuity of utilization for follow-up of previous health problems, prevention and investigation of a new problem. The collective development of actions to promote accessibility and utilization resulted in the creation of a flowchart, as a tool for transformation of reality. This research allowed to broaden the view on the urgency for articulation in the network of attention to women living with HIV, in view of the need to promote improvement of the access, concerning the accessibility and utilization of services of the healthcare network.